You should have received your SBC when you enrolled in your plan. SBCs describe key features such as the covered benefits, cost-sharing provisions, and coverage limitations and exceptions of your plan. Information in SBCs represents an overview of your coverage.

You can also find your SBC by logging in to Blue Access for MembersSM (BAMSM). After you log in, you will see a My Coverage tab. When you click on that tab, there is a My Coverage box on the left. Select Medical. A link to your SBC will be below your plan name.

The table on page one of your plan’s SBC starts with Important Questions in the first column and Answers in the second column. The third column, Why This Matters, explains how the answer may affect you.

The next pages of the SBC show Common Medical Events in the left column. These range from doctor office visits and tests to emergency care and hospital stays. The SBC also includes details about drug coverage.

Then the SBC lists Services You May Need for each common medical event.

The What You Will Pay column is split into Participating Provider (in network) and Non-Participating Provider (out of network). Generally, you will pay less when you use a participating provider (in network).

If you have an HMO plan, you will see “not covered” in the Non-Participating Provider column. Note there may be exceptions for emergency care in some cases.

The last column, Limitations, Exceptions, & Other Important Information, provides examples of when your benefit may not apply or special steps you may need to take to use that benefit.

The SBC also lists Excluded Services, which are common services that are not covered by your plan, as well as Other Covered Services.

The Coverage Examples are one of the most useful parts of the SBC. These examples break down costs for different medical events. First, the examples list plan deductibles, copays and coinsurance. Then you see details of the services covered and a Total Example Cost. Finally, the coverage examples show the total Cost-Sharing.

The SBC is a great place to start for a quick review of your plan. For more details, look for your Benefit Book in BAM.

Your SBC explains your rights.

Do you know that you have specific rights as a health care consumer? Your SBC includes information on what your rights and responsibilities are as a Blue Cross and Blue Shield of New Mexico member. For example:

Your rights to continue coverage: There are organizations that can help if you want to continue your coverage after it ends. This section of the SBC provides multiple contact options for you to get that help if you need it.

Your grievance and appeals rights: If you have a concern about a denied claim, you have options for resolving the issue. There are places that can help if you want to appeal. For more information about your rights, look at your explanation of benefits (EOB) for the claim. Your plan documents also provide complete information about how to submit a claim, appeal or a grievance.

Does this plan provide Minimum Essential Coverage? Your SBC will answer Yes or No to this question. Most individuals are required to have health coverage that meets certain minimums. If you don’t have Minimum Essential Coverage for a month or longer, you may have to make a payment when you file your tax return. Some people do qualify for an exemption from the requirement.

Language access services: You may be able to have your health plan information translated for you. Your SBC lists which languages are available and the number to call for each. The available languages are chosen based on the percent of the state population that speaks each language.